Impact of COVID-19 Infection on Blood Pressure Variability and Cardiovascular Outcomes in Hypertensive Patients After Complete Liberalization of Epidemic Control in China.

This retrospective cohort study assessed the effect of COVID-19 infection on blood pressure variability (BPV) and cardiovascular outcomes in hypertensive patients using 24-h ambulatory blood pressure monitoring and structural equation modeling (SEM). Among 318 patients followed for 2 years, those with infection and poor prognosis showed the most abnormal hemodynamic patterns, including markedly elevated nocturnal SBP load (70.0% vs. 50.1%), higher ARVDBP (9.8% vs. 8.2%), wider pulse pressure (60.9 mmHg), and lower time in target range (30.9% vs. 74.7%, p < 0.001). Cox regression identified infection status, nocturnal BP load, and BP variability as major risk factors, while multivariate models confirmed 11 independent predictors. Neither diabetes nor antihypertensive medication class modified these associations. SEM demonstrated that infection influenced prognosis indirectly through elevated nighttime BP level, load, and variability (indirect effect β = 0.098, p < 0.001). Mechanistically, infection-driven endothelial dysfunction, microthrombotic activation, and autonomic dysregulation, rather than prolonged inactivity, likely underlie the nocturnal amplification of BP instability. These findings support the need for individualized hypertension management during and after infection, focusing on renin-angiotensin system balance, continuation of ACEI/ARB therapy, nighttime dosing of long-acting agents, and circadian BP monitoring to mitigate long-term cardiovascular risk.